54 research outputs found
Informational Digest Bulletin from San Raffaele (No 18). A New Research Project in Rome Between San Raffaele Research Institute and Faculty of Education at the Università degli Studi Roma Tre
No full textEnergy analysis of gait in patients with down syndrome
No full textBackground: the primary aim of this study is to analyse the energy parameters of patients with Down syndrome compared to a control group and secondly to verify whether the sport activity leads to differences in energy expenditure.Methods: 3 groups of subjects were identified: 8 healthy subjects and 147 subjects with Down syndrome, of whom 14 played sports at least once a week. An energy index was calculated, given by the ratio between potential and kinetic energy. Next, kinetic ad potential energy parameters were extrapolated at 60% of the gait cycle (pro-pulsion phase).Findings: Down syndrome group was compared with the control group and emerged that the energy index was higher in the first one. No changes were found between Down syndrome and Down syndrome Sport groups. The analysis of the energy parameters showed that all parameters, except the medio-lateral kinetic energy, were higher in the control than in the Down syndrome groups. The potential energy, medio-lateral kinetic energy, and vertical were higher in the Down syndrome Sport group than in the Down syndrome group. The kinetic energy and the mean velocity were higher in the control group than in Down syndrome Sport group while the medio-lateral kinetic energy was lower.Interpretation: sport modified the parameter of potential energy but not that of kinetic energy, which continued to be different compared to the healthy group and increased the oscillations in the medio-lateral plane, which were double compared to Down syndrome group. The increase in potential energy, found to be almost equal to that of control group, indicates an increase in vertical oscillations. This could be because subjects who practise sports have stronger muscles that allow a greater push-off ability, which therefore increases their potential energy
Mechanical Work and Power Analysis in the Joints of the Lower Extremity of Adults With Down Syndrome During Plane Walking
No full textIndividuals with Down syndrome (DS) use a different motor gait strategy than healthy people. This study aims at analyzing plane walking differences between two groups of normally developed (ND) subjects and subjects with DS in terms of the generated mechanical power and work in the joints of the lower limb. Thirty-nine adults including two groups of 21 subjects with DS (age: 21.6 ± 7 years (mean ± SD)) and 18 ND subjects (age: 25.1 ± 2.4 years) participated in this study. Gait data and ground reaction forces were acquired using a quantitative movement analysis system composed of an optoelectronic motion analyzer (Elite2002, BTS) with eight infrared cameras, and two force platforms mounted in the middle of walkway. Mechanical power and work exchanges were computed during the stance phase by dedicated software, and then compared between the two groups (significance level: p-value = 0.05). Results showed that the mechanical power at the ankle joint was significantly larger in ND subjects compared to subjects with DS (0.084 ± 0.015 vs 0.027 ± 0.010 W/kg). The mechanical work of the ankle joint and the knee joint was significantly lower in ND compared to DS (0.015 ± 0.013 vs 0.028 ± 0.008 kJ/kg.m, and 0.066 ± 0.031 vs 0.109 ± 0.023 kJ/kg.m, respectively). For both groups, the mechanical work done by knee was less than that performed at the ankle and hip level, which might indicate that the knee muscles mainly absorb the energy, rather than generate it. Our results suggest that the subjects with DS walk with a different motor strategy than normal subjects in terms of mechanical power and work in the joints of the lower extremity. Further investigations are warranted to study the relation between these parameters and gait strategy in subjects with DS, which can lead to better rehabilitative strategies.</jats:p
A biomechanical study of gait initiation in Down syndrome
No full textGait Initiation (GI) is a functional task that challenges the balance control requiring weight shift and a transition from standing to walking. Individuals with Down Syndrome (DS) walk with low velocity, prolonged stance and shorter steps beside an increased support base. However, no studies performed GI analysis on this population. The aim of this study is to quantitatively characterize the GI task in subjects with DS compared with a typically developed control group
Sex differences in the gait kinematics of patients with Down syndrome: A preliminary report
No full textOBJECTIVE: Sex-specific medicine requires understanding of the specific therapeutic needs and patho-physiology of men and women. In these terms, we investigated sex-related differences in the gait kinematics of patients with Down syndrome. DESIGN: Retrospective observational cohort study. SUBJECTS: A sample of 230 patients (103 females) aged 7-50 years underwent a standard gait-analysis test from 2000 to 2015. METHODS: Spatiotemporal gait parameters and synthetic indexes were computed as Gait Profile Score (GPS) and pelvis/lower limbs as Gait Variable Scores. RESULTS: Although speed, normalized step width, %stance and %swing were similar, in female patients step length was shorter and GPS was higher than in male patients, with no significant effect of age, speed and body mass index. Sex-specific features were found at the pelvis, hip and knee level (sagittal plane), and at the ankle level (transverse plane). CONCLUSION: Overall, in people with Down syndrome, the gait function of females tends to be more impaired than in males, with the exception of foot progression. Therapists should consider these differences when evaluating the severity of gait impairment and designing rehabilitation strategies
Use of 3D gait analysis as predictor of achilles tendon lengthening surgery outcomes in children with cerebral palsy
No full textBACKGROUND: In children with spastic Cerebral Palsy (CP), the treatment of equinus foot with Achilles tendon lengthening (ATL) surgery is associated with high incidence of overcorrection, which may result in crouch gait.
AIM: We aimed to assess if gait pattern in preoperative time could be a predictor of the surgery outcome.
DESIGN: Cross-sectional retrospective study.
SETTING: Movement Analysis Lab, IRCCS San Raffaele Pisana Hospital, Rome (ITALY).
POPULATION: Eighteen children (mean age 9.64.7 years) with spastic diplegia CP who underwent bilateral ATL surgery to correct equinus foot were involved.
METHODS: Participants underwent 3D gait analysis before and approximately 12 months after surgery. Primary measures were spatiotemporal, kinematic (summarized by Gait Variable Scores, GVSs) and kinetic parameters. The gait patterns for each leg was defined from kinematic data, using a quantitative classification: Plantar Flexor Knee Extension (PFKE) index. The CP group was split into true equinus and jump gait.
RESULTS: The equinus foot was successfully corrected as demonstrated by the improvement of GVS ankle dorsi-plantarflexion. However, there was a high rate of overcorrection in the true equinus, characterized by increases in knee flexion- extension GVS (8.7° pre vs. 16.7° post P<0.05) and knee flexion angle at initial contact (5.2° vs. 20.6° P<0.05) and by a decrease in the maximum ankle power generated at push-off (1.49 vs. 0.83 W/kg P <0.05).
CONCLUSIONS: Assessment of motor phenotype in preoperative time are good predictors of the results of ATL surgery. In children with true equinus gait, the increase of knee flexion subsequent to ATL is an early indicator that this technique will lead to crouch gait. These results show the influence of true equinus and jump gait patterns on the outcomes of the ATL.
CLINICAL REHABILITATION IMPACT: Therefore, we propose that this approach could have clinical value to evaluate and prescribe rehabilitation in children with CP disease, proposing different solutions depending on motor phenotype
A proposal for a kinetic summary measure: the Gait Kinetic Index
No full textA new summary index for kinetic gait data is proposed (Gait Kinetic Index - GKI), BASED on six kinetic selected variables: hip, knee and ankle moments and powers on the sagittal plane. This method was applied on a control group (CG) of 18 subjects and on 57 patients with diplegic Cerebral Palsy (CP). CP showed statistical different GKI value in comparison with CG. The same is for the sub GKI with the exclusion of GKI Knee Power. The GKI seems to be a promising tool useful to measure extensively the gait pathology taking into consideration kinetic aspects of gait pattern
Study of Cardiac Features in Adults with Down Syndrome
No full textDown Syndrome (DS) has a significant impact on the development of many tissues, most notably in the heart and in the brain. According to the clinical need to better investigate these aspects, the main aim of this study was to make an overview on the cardiac features in adult individuals with DS.
The following data of 37 individuals with DS (range: 18-60 years) were collected and analysed: age, gender, height, weight, waist to height ratio (WHER), smoking history and cardiac parameters (heart rate and blood pressure), blood glucose level or glycaemia, cholesterol (total, high-density lipoprotein – HDL - and low-density lipoprotein - LDL - cholesterol) and triglycerides. In addition, their gait pattern were quantified with 3D Gait Analysis.
BMI, WHER and cholesterol HDL results were above the upper limits of the recommended range in people with DS; on the contrary, blood pressure, heart rate, glycaemia, cholesterol-LDL and triglycerides were within the recommended range. Comparing males and females in the DS group, the females showed statistically different values for cholesterol-total, and triglycerides values, with lower values in comparison to males. In motor performance, people with DS presented abnormal gait patterns. Some significant correlations were found: age with LDL, WHER with weight and BMI, systolic with diastolic blood pressure, total cholesterol with LDL and triglycerides.
Our results showed that adults with DS suffer from a high prevalence of physical disorders, including overweight and obesity, and abnormal cholesterol values, together with abnormal gait pattern
Slip avoidance strategies in children with bilateral spastic cerebral palsy and crouch gait
No full textBackground: A slip occurs when the required friction (RCOF) to prevent slipping at the foot/floor interfaces exceeds the available friction. The RCOF is dependent upon the biomechanics features of individuals and their gait. On the other hand, the available friction depends on environmental features. Once individuals with crouch gait have their biomechanics of gait completely altered, how do they interact with a supporting surface? The aim was to quantify the RCOF in children with bilateral spastic cerebral palsy (BSCP) and crouch gait.
Methods: 11 children with crouch gait and 11 healthy age-matched children were instructed to walk barefoot at self-selected speed over a force platform. The RCOF curve was obtained as the ratio between the tangential forces (FT), and the vertical ground reaction force (FZ). Three points were extracted by the RCOF, FT and FZ curves at the loading response, midstance and push-off phases.
Findings: Children with BSCP presented higher values of RCOF in all support phase and lower gait velocity relative to the healthy controls. For BSCP group no correlation between FT and FZ were found, indicating that this group is not able to negotiate the forces during the support phase.
Interpretation: Children with BSCP and crouch gait are not able to negotiate the forces applied on the ground in support phase, so to avoid the fall, their strategy is to reduce the gait velocity
An examination of the relationship between dynamic knee joint stiffness and gait pattern of children with cerebral palsy
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